Skip to main content
SpringerLink
Log in

“Shift and cover technique”: conservative management of complications for the rescue of S-ICD subcutaneous implantable defibrillator systems

  • Review
  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

The risk of complications has been shown to be lower with subcutaneous implantable defibrillator (S-ICD) than with conventional ICDs. Given the low frequency of complications, experience of how to manage them is limited. In this paper, we describe generator- and lead-related complications recorded in a series of S-ICD patients, and we propose our conservative approach to managing them.

Methods

The study cohort consisted of S-ICD patients who were referred to our institution owing to generator- or lead-related complications requiring surgical intervention. With our “shift and cover” approach, the system component involved is moved from its original position to an alternative, more protected location. In the case of the generator, this involves moving it to an intermuscular pocket. In the case of infections at the parasternal scar, the electrode sleeve is moved away from its original location, stitched, and then covered with the muscular fascia.

Results

Fourteen S-ICD patients were referred to our institution owing to system-related complications. Complications involved the generator in 7 cases (deep pocket infections with erosion, extrusion, or pain), the lead in 5 cases (parasternal infections at the xyphoid incision site), and both the generator and the lead in 2 cases. Complications were managed without completely removing the device and resolved in a single surgical session with no intraoperative complications. During defibrillation testing, the first shock at 65 J was effective in all patients. The shock impedance after revision was significantly lower than that measured during first implantation (59 ± 10 Ohm versus 86 ± 24 Ohm, P = 0.013). In all cases, the cosmetic result was satisfactory. No complications or recurrent infections were reported at the 12-month follow-up visit.

Conclusions

The proposed conservative approach was successful in managing S-ICD complications. The revision procedure allowed to optimize the system configuration in terms of the defibrillation vector, resulting in lower shock impedance values and better device positioning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Weiss R, Knight BP, Gold MR, Leon AR, Herre JM, Hood M, Rashtian M, Kremers M, Crozier I, Lee KL, Smith W, Burke MC. Safety and efficacy of a totally subcutaneous implantable-cardioverter defibrillator. Circulation. 2013;128:944–53.

    Article  Google Scholar 

  2. Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ, ESC Scientific Document Group. ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36:2793–867.

    Article  Google Scholar 

  3. Knops RE, van der Stuijt W, Smeding L. Subcutaneous or transvenous defibrillator therapy. Reply N Engl J Med. 2021;384:678–9.

    PubMed  Google Scholar 

  4. Rordorf R, Casula M, Pezza L, Fortuni F, Sanzo A, Savastano S, Vicentini A. Subcutaneous versus transvenous implantable defibrillator: an updated meta-analysis. Heart Rhythm. 2021;18:382–91.

    Article  Google Scholar 

  5. Droghetti A, Basso Ricci E, Scimia P, Harizai F, Marini M. Ultrasound-guided serratus anterior plane block combined with the two-incision technique for subcutaneous ICD implantation. Pacing Clin Electrophysiol. 2018;41:517–23.

    Article  Google Scholar 

  6. Winter J, Siekiera M, Shin DI, Meyer C, Kröpil P, Clahsen H, O’Connor S. Intermuscular technique for implantation of the subcutaneous implantable cardioverter defibrillator: long-term performance and complications. Europace. 2017;19:2036–41.

    Article  Google Scholar 

  7. Francia P, Biffi M, Adduci C, Ottaviano L, Migliore F, De Bonis S, Dello Russo A, De Filippo P, Viani S, Bongiorni MG, Caravati F, Lavalle C, Landolina ME, Pisanò E, Giorgi D, Lovecchio M, Valsecchi S, Diemberger I. Implantation technique and optimal subcutaneous defibrillator chest position: a PRAETORIAN score-based study. Europace. 2020;22:1822–9.

    Article  Google Scholar 

  8. Burke MC, Gold MR, Knight BP, Barr CS, Theuns DAMJ, Boersma LVA, Knops RE, Weiss R, Leon AR, Herre JM, Husby M, Stein KM, Lambiase PD. Safety and efficacy of the totally subcutaneous implantable defibrillator: 2-year results from a pooled analysis of the IDE study and EFFORTLESS Registry. J Am Coll Cardiol. 2015;65:1605–15.

    Article  Google Scholar 

  9. Lambiase PD, Theuns DA, Murgatroyd F, Barr C, Eckardt L, Neuzil P, Scholten M, Hood M, Kuschyk J, Brisben AJ, Carter N, Stivland TM, Knops R, Boersma LVA. Subcutaneous implantable cardioverter-defibrillators: long-term results of the EFFORTLESS study. Eur Heart J. 2022;28:ehab921.

    Google Scholar 

  10. Ziacchi M, Bisignani G, Palmisano P, Scalone A, Martignani C, Elvira Mocavero P, Caravati F, Della Cioppa N, Mazzuero A, Pecora D, Vicentini A, Landolina ME, Debonis S, Scimia P, Lovecchio M, Valsecchi S, Diemberger I, Droghetti A. Serratus anterior plane block in subcutaneous implantable cardioverter defibrillator implantation: a case-control analysis. J Cardiovasc Electrophysiol. 2020;31:144–9.

    Article  Google Scholar 

  11. Droghetti A, Fusco P, Marini M, Harizai F, Scimia P. Ultrasound-guided serratus anterior plane block and parasternal block in cooperative sedation for S-ICD implantation. Pacing Clin Electrophysiol. 2019;42:1076–8.

    Article  Google Scholar 

  12. Botto GL, Forleo GB, Capucci A, Solimene F, Vado A, Bertero G, Palmisano P, Pisanò E, Rapacciuolo A, Infusino T, Vicentini A, Viscusi M, Ferrari P, Talarico A, Russo G, Boriani G, Padeletti L, Lovecchio M, Valsecchi S, D’Onofrio A. ‘AIAC S-ICD Why Not’ Survey Investigators. The Italian subcutaneous implantable cardioverter-defibrillator survey: S-ICD, why not? Europace. 2017;19:1826–32.

    Article  Google Scholar 

  13. Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Sághy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;41:2012–32.

    Article  Google Scholar 

  14. Le KY, Sohail MR, Friedman PA, Uslan DZ, Cha SS, Hayes DL, Wilson WR, Steckelberg JM, Baddour LM. Mayo Cardiovascular Infections Study Group. Impact of timing of device removal on mortality in patients with cardiovascular implantable electronic device infections. Heart Rhythm. 2011;8:1678–85.

    Article  Google Scholar 

  15. Lopez JA. Conservative management of infected pacemaker and implantable defibrillator sites with a closed antimicrobial irrigation system. Europace. 2013;15:541–5.

    Article  Google Scholar 

  16. Puri R, Psaltis PJ, Nelson AJ, Sanders P, Young GD. Povidone-iodine irrigation — a possible alternative to lead extraction. Indian Pacing Electrophysiol J. 2011;11:115–9.

    PubMed  PubMed Central  Google Scholar 

  17. Poller WC, Schwerg M, Melzer C. Therapy of cardiac device pocket infections with vacuum-assisted wound closure-long-term follow-up. Pacing Clin Electrophysiol. 2012;35:1217–21.

    Article  Google Scholar 

  18. Kusumoto FM, Schoenfeld MH, Wilkoff BL, Berul CI, Birgersdotter-Green UM, Carrillo R, Cha YM, Clancy J, Deharo JC, Ellenbogen KA, Exner D, Hussein AA, Kennergren C, Krahn A, Lee R, Love CJ, Madden RA, Mazzetti HA, Moore JC, Parsonnet J, Patton KK, Rozner MA, Selzman KA, Shoda M, Srivathsan K, Strathmore NF, Swerdlow CD, Tompkins C, Wazni O. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017;14:e503–51.

    Article  Google Scholar 

  19. Brouwer TF, Driessen AHG, Olde Nordkamp LRA, Kooiman KM, de Groot JR, Wilde AAM, Knops RE. Surgical management of implantation-related complications of the subcutaneous implantable cardioverter-defibrillator. JACC Clin Electrophysiol. 2016;2:89–96.

    Article  Google Scholar 

  20. Baddour LM, Weiss R, Mark GE, El-Chami MF, Biffi M, Probst V, Lambiase PD, Miller MA, McClernon T, Hansen LK, Knight BP. Diagnosis and management of subcutaneous implantable cardioverter-defibrillator infections based on process mapping. Pacing Clin Electrophysiol. 2020;43:958–65.

    Article  Google Scholar 

  21. Francia P, Adduci C, Angeletti A, Ottaviano L, Perrotta L, De Vivo S, Bongiorni MG, Migliore F, Russo AD, De Filippo P, Caravati F, Nigro G, Palmisano P, Viani S, D’Onofrio A, Lovecchio M, Valsecchi S, Ziacchi M. Acute shock efficacy of the subcutaneous implantable cardioverter-defibrillator according to the implantation technique. J Cardiovasc Electrophysiol. 2021;32:1695–703.

    Article  Google Scholar 

  22. D’Onofrio A, Pieragnoli P, Biffi M, Nigro G, Migliore F, Francia P, De Filippo P, Capucci A, Botto GL, Giammaria M, Palmisano P, Pisanò E, Bisignani G, La Greca C, Sarubbi B, Sala S, Viscusi M, Landolina M, Lovecchio M, Valsecchi S, Bongiorni MG. “S-ICD Rhythm Detect″ Investigators. Subcutaneous implantable cardioverter defibrillator implantation: an analysis of Italian clinical practice and its evolution. Int J Cardiol. 2018;272:162–7.

    Article  Google Scholar 

  23. Amin AK, Gold MR, Burke MC, Knight BP, Rajjoub MR, Duffy E, Husby M, Stahl WK, Weiss R. Factors associated with high-voltage impedance and subcutaneous implantable defibrillator ventricular fibrillation conversion success. Circ Arrhythm Electrophysiol. 2019;12:e006665.

    Article  Google Scholar 

  24. Heist EK, Belalcazar A, Stahl W, Brouwer TF, Knops RE. Determinants of subcutaneous implantable cardioverter-Defibrillator efficacy: a computer modeling study. JACC Clin Electrophysiol. 2017;3:405–14.

    Article  Google Scholar 

  25. Biffi M, Bongiorni MG, D’Onofrio A, Manzo M, Pieragnoli P, Palmisano P, Ottaviano L, Perego GB, Pangallo A, Lavalle C, Bonfantino V, Nigro G, Landolina ME, Katsouras G, Diemberger I, Viani S, Bianchi V, Lovecchio M, Valsecchi S, Ziacchi M. “S-ICD Rhythm Detect” Investigators. Is 40 joules enough to successfully defibrillate with subcutaneous implantable cardioverter-defibrillators? JACC Clin Electrophysiol. 2021;7:767–76.

    Article  Google Scholar 

  26. Boersma L, Barr C, Knops R, Theuns D, Eckardt L, Neuzil P, Scholten M, Hood M, Kuschyk J, Jones P, Duffy E, Husby M, Stein K, Lambiase PD. EFFORTLESS Investigator Group. Implant and midterm outcomes of the subcutaneous implantable cardioverter-defibrillator registry: The EFFORTLESS study. J Am Coll Cardiol. 2017;70:830–41.

    Article  Google Scholar 

  27. van der Stuijt W, Quast ABE, Baalman SWE, de Wilde KC, Brouwer TF, Wilde AAM, Knops RE. Complications related to elective generator replacement of the subcutaneous implantable defibrillator. Europace. 2021;23:395–9.

    Article  Google Scholar 

  28. Smietana J, Frankel DS, Serletti JM, Arkles J, Pothineni NVK, Marchlinski FE, Schaller RD. Subserratus implantation of the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm. 2021;18:1799–804.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Luca Auricchio (Boston Scientific) for his valuable collaboration in the critical revision of the manuscript.

Author information

Authors and Affiliations

  1. Thoracic Surgery Division, ASST Mantova, Viale Lago Paiolo 10, 46100, Mantua, Italy

    Andrea Droghetti

  2. Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy

    Domenico Pecora

  3. Division of Cardiology, Ospedale SS, Trinità, Borgomanero Hospital, Novara, Italy

    Stefano Maffè

  4. Department of Cardiology, S. Andrea Hospital, La Spezia, Italy

    Sandra Badolati

  5. Cardiology Division, ASST Mantova, Mantua, Italy

    Patrizia Pepi & Daniele Nicolis

  6. Arrhythmia and Electrophysiology Center,I.R.C.C.S. MultiMedica, Sesto San Giovanni (MI), Italy

    Pierpaolo Lupo

  7. Boston Scientific, Milan, Italy

    Mariolina Lovecchio & Sergio Valsecchi

  8. Arrhythmia and Electrophysiology unit, Cardiothoracic Department Clinical Institute S. Ambrogio, Milan, Italy

    Luca Ottaviano

Authors
  1. Andrea Droghetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Domenico Pecora
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefano Maffè
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandra Badolati
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrizia Pepi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniele Nicolis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pierpaolo Lupo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mariolina Lovecchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sergio Valsecchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Luca Ottaviano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Droghetti.

Ethics declarations

Competing interests

Dr. Andrea Droghetti and Dr. Luca Ottaviano are consultants for Boston Scientific. The other authors report no conflicts.

Informed consent

Before the procedure, each patient signed an informed consent form approved by the institutional review board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 15 KB)

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Droghetti, A., Pecora, D., Maffè, S. et al. “Shift and cover technique”: conservative management of complications for the rescue of S-ICD subcutaneous implantable defibrillator systems. J Interv Card Electrophysiol (2022). https://doi.org/10.1007/s10840-022-01312-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10840-022-01312-y

Keywords

Search

Navigation